Neuropsychiatric Disorders in Multiple Sclerosis: Assessment and Management

Background:

Psychiatric disorders are highly prevalent in patients with Multiple Sclerosis (MS), but they are often under recognized and undertreated. Importantly, treating these disorders may improve these individuals’ emotional well-being, quality of life, adherence to MS treatment, and prognosis.

Objectives:

To summarize the clinical presentation of the most prevalent psychiatric disorders in Multiple Sclerosis and present a systematic, evidence- based approach for their assessment and management.

Methods:

We reviewed the literature on neuropsychiatric disorders in MS. We designed and implemented in our clinic a systematic and evidence- based approach for the assessment of neuropsychiatric disorders in this population. 

Results:

We discuss the prevalence, pathophysiology, clinical presentation, assessment and treatment of various neuropsychiatric disorders in MS with emphasis on Mood and Anxiety Disorders, Cognitive Disorders, and affect disturbances (Pathological Laughing and Crying). The phenomenology of neuropsychiatric disorders in MS may be different from the classic presentations we see in primary psychiatric disorders. Highly frequent MS symptoms such as fatigue, pain, and sleep disturbances may be comorbid. The quality of emotional and affect manifestations may be affected by the presence of brain lesions, polypharmacy, and other factors. We present a systematic, comprehensive and efficient clinical approach for the psychiatric assessment and management of these patients. This model combines the active screening of the most prevalent psychiatric and non-psychiatric disorders in this population, including the use of validated scales. We present an interdisciplinary and comprehensive treatment approach that includes: Disease modifying drugs; psychopharmacology, brain stimulation, and other biological treatments; complementary and alternative approaches; treatment of frequently comorbid MS symptoms such as fatigue and pain; psychotherapy; cognitive rehabilitation; physical therapy and occupational therapy. 

Conclusions:

The screening, assessment and treatment of neuropsychiatric disorders in MS in the context of an interdisciplinary model may improve the quality of life and prognosis of these patients.